| NPI | 1134268006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N2886) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA A102690) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 23818) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2016-07-05 |